Korean J Clin Neurophysiol.  2014 Dec;16(2):70-73. 10.14253/kjcn.2014.16.2.70.

Nonconvulsive Status Epilepticus Associated with Hashimoto's Encephalopathy

• Lee JJ
• Kang K
• Park JM
• Shin H
• Kwon O
• Kim BK

• KMID: 1737967
• DOI: http://doi.org/10.14253/kjcn.2014.16.2.70

Abstract

Nonconvulsive status epilepticus usually presents with altered mentation without distinct manifestations of seizures. It may be related with various medical disorders. Hashimoto's encephalopathy is characterized by various neurological manifestations accompanied by high titers of anti-thyroid antibodies. Here, we report a patient with nonconvulsive status epilepticus caused by Hashimoto's encephalopathy who showed a dramatic response to steroids.

Keyword

Nonconvulsive status epilepticus; Hashimoto's encephalopathy; Immunologic treatment

MeSH Terms

Antibodies
Humans
Neurologic Manifestations
Seizures
Status Epilepticus*
Steroids
Antibodies
Steroids

Figure

• 

  Figure 1. Diffusion MRI shows no acute lesion other than remnant tumor and minimal hematoma in left pons and cerebellum.

• 

  Figure 2. Frequent sharp-and-slow waves are observed in the left occipital area (A). Intermittent rhythmic delta activity in the left occipital area spreads to the right occipital and bilateral frontotemporal area with evolution to higher amplitude (B).

• 

  Figure 3. Frequent sharp-and-slow waves in the left occipital area spread to the right occipital area and the left frontotemporal area with evolving to semirhythmic delta activity (A). Rhythmic sharp and slow waves sometimes appeared in the left or right frontotemporal area (B).

• 

  Figure 4. Follow-up EEG after steroid pulse therapy. Background alpha rhythms are well regulated with a little amount of intermittent frontotemporal slowing. EEG; electroencephalogram.

Reference

1.Niedermeyer E., Khalifeh R. Petit mal status (“spike-wave stupor”): an electro-clinical appraisal. Epilepsia. 1965. 6:250–262.

2.Meierkord H., Holtkamp M. Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol. 2007. 6:329–339.

3.Schiess N., Pardo CA. Hashimoto's encephalopathy. Ann N Y Acad Sci. 2008. 1142:254–265.

4.Chong JY., Rowland LP., Utiger RD. Hashimoto encephalopathy: syndrome or myth? Arch Neurol. 2003. 60:164–171.

5.Maganti R., Gerber P., Drees C., Chung S. Nonconvulsive status epilepticus. Epilepsy Behav. 2008. 12:572–586.

6.Kaplan PW. EEG criteria for nonconvulsive status epilepticus. Epilepsia. 2007. 48(suppl 8):39–41.

7.Brain L., Jellinek EH., Ball K. Hashimoto's disease andencepha-lopathy. Lancet. 1966. 2:512–514.

8.Engum A., Bjøro T., Mykletun A., Dahl AA. Thyroid autoimmunity, depression and anxiety; are there any connections? An epidemiological study of a large population. J Psychosom Res. 2005. 59:263–268.

9.Selva-O'Callaghan A., Redondo-Benito A., Trallero-Araguás E., Martínez-Gómez X., Palou E., Vilardell-Tarres M. Clinical significance of thyroid disease in patients with inflammatory myopathy. Medicine (Baltimore). 2007. 86:293–298.

10.Genovesi G., Paolini P., Marcellini L., Vernillo E., Salvati G., Polidori G, et al. Relationship between autoimmune thyroid disease and Alzheimer's disease. Panminerva Med. 1996. 38:61–63.